“This is, I think, one of the biggest unaddressed issues in modern medicine,” says the author of a new study surveying medication use among people with diabetes. The issue to which he refers is known as “medication nonadherence” — that is, the situation that arises when patients don’t take the drugs their physicians prescribe for them.
The observation comes from Pankaj Gupta, DPB, of the University of Leicester in Great Britain. Together with his colleague Prashanth Patel, MSc, he developed an easy-to-use method of determining nonadherence to medication among diabetes patients and published the results in the journal Diabetes Care.
Simply asking patients if they are taking their medications is obviously not the best way to get accurate information. So the researchers, for the first time, used a technique called liquid chromatography-tandem mass spectrometry to assess medication adherence. They did this by obtaining and assessing urine samples from 228 patients who were attending an annual diabetes checkup. The researchers say that the mass spectrometry procedure can identify in a urine sample 60 commonly used medications. They then divided the results into three categories: nonadherence (no presence of medication in the urine), partial adherence (detection of at least one, but not all, of the prescribed medications), and total adherence (the presence of all prescribed medications).
The results determined that almost one-third (28.1%) of the subjects were not fully adhering to their medication regimens and 5.7% were totally nonadherent. And nearly one out of ten (9.3%) of the diabetes patients were not taking their diabetes medications. The medications most likely to be skipped were statins, which, said Dr. Gupta, “was sort of expected,” given that statins have been getting some bad press lately. The researchers also found, unsurprisingly, that nonadherent or partial-adherent patients had higher levels of blood sugar (according to an HbA1c test, which measures glucose control over the previous 2–3 months) and higher cholesterol levels.
The one encouraging take-away from the study, according to the researchers, is that it can facilitate doctor–patient communication. Although the mass spectrometry test is not universally available, when it is used, said Dr. Gupta, “it often breaks down the barriers of discussing nonadherence with patients. It doesn’t depend on the judgment of the clinician or a health-care professional to decide if a patient is taking his medication or not. Then you can have an objective discussion with patients about why they are forgetting their medications.”
A freelance writer and editor based in the Chicago area, Gustaitis has a degree in journalism from Columbia University.